NPI | 1760577167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA PC003162) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC003162) |
101YM0800X Counselor, Mental Health (Licence: PA PC003162) | |
101YP2500X Counselor, Professional (Licence: PA PC003162) | |
Enumeration Date | 2006-10-03 |
Last Update Date | 2025-09-11 |